Provider Demographics
NPI:1023592904
Name:OAKS, CODY LEWIS (MA, LPCC)
Entity type:Individual
Prefix:MR
First Name:CODY
Middle Name:LEWIS
Last Name:OAKS
Suffix:
Gender:M
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 2ND ST NE STE 210
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-2993
Mailing Address - Country:US
Mailing Address - Phone:612-405-0830
Mailing Address - Fax:763-999-5972
Practice Address - Street 1:1302 2ND ST NE STE 210
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-2993
Practice Address - Country:US
Practice Address - Phone:612-405-0830
Practice Address - Fax:763-999-5972
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC01877101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor